The relationship between good collateral development and magnesium/phosphate ratio in chronic total occlusion
Abstract
Objective: Coronary collateral formation can be triggered by many acquired factors such as ischemia and growth factors, which ultimately manifests as differences in the quality of the coronary collateral circulation (CCC) in patients. Low magnesium (Mg) levels can increase endothelial cell dysfunction and potentially increase the risk of thrombosis and atherosclerosis. However, it has been reported that high serum phosphate (P) levels are correlated with the development of atherosclerosis and mortality. In this article, we aimed to reveal the relationship between CCC quality and Mg/P ratio in chronic total occlusion (CTO).
Methods: A total of 269 patients with detected CTO in coronary angiography between March 2014 and June 2018 were included in the study. The patients were divided into two groups as group I (127 patients) and group II (142 patients) according to the Rentrop classification. The study is a retrospective, observational study.
Results: In the multivariable regression analysis; smoking (p=0.004), triglyceride (p<0.001) and Mg/P ratio (p<0.001) parameters were independent predictors affecting CCC in CTO. Mg/P value was statistically lower in the group I (0.49±0.17) than group II (0.62±0.12) (p <0.001). The ideal Mg/P cut-off value was 0.56 that calculated by the Youden index had 69% sensitivity, and 64% specificity for collateral development of CTO.
Conclusion: Mg/P is a parameter that affects coronary collateral development. High Mg/P ratio level is associated with good collateral development in patients who had CTO.
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References
- McMurtry MS, Lewin AM, Knudtson ML, Ghali WA, Galbraith PD, Schulte F, et al. The clinical profile and outcomes associated with coronary collaterals in patients with coronary artery disease. Can J Cardiol. 2011;27(5):581-8. doi: 10.1016/j.cjca.2011.02.011.
- Nacar AB, Erayman A, Kurt M, Buyukkaya E, Karakaş MF, Akcay AB, et al. The relationship between coronary collateral circulation and neutrophil/lymphocyte ratio in patients with coronary chronic total occlusion. Med Princ Pract. 2015;24(1):65-9. doi: 10.1159/000365734.
- Cui K, Lyu S, Song X, Yuan F, Xu F, Zhang M, et al. Effect of coronary collaterals on prognosis in patients undergoing primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: a meta-analysis. Angiology. 2018; 69:803–11. doi: 10.1177/0003319718768399.
- Volpe SL. Magnesium, the metabolic syndrome, insulin resistance, and type 2 diabetes mellitus. Crit Rev Food Sci Nutr. 2008;48:293–300.
- DiNicolantonio JJ, Liu J, O'Keefe JH. Magnesium for the prevention and treatment of cardiovascular disease. Open Heart. 2018;5(2):e000775. doi: 10.1136/openhrt-2018-000775.
- Li Q, Chen Q, Zhang H, Xu Z, Wang X, Pang J, et al. Associations of serum magnesium levels and calcium-magnesium ratios with mortality in patients with coronary artery disease. Diabetes Metab. 2020;46(5):384-391. doi: 10.1016/j.diabet.2019.12.003.
- Fang X, Liang C, Li M, Montgomery S, Fall K, Aaseth J, et al. Dose-response relationship between dietary magnesium intake and cardiovascular mortality: a systematic review and dose-based meta-regression analysis of prospective studies. J Trace Elem Med Biol. 2016;38:64–73.
- Maier JA, Malpuech-Brugère C, Zimowska W, Rayssiguier Y, Mazur A. Low magnesium promotes endothelial cell dysfunction: implications for atherosclerosis, inflammation and thrombosis. Biochim Biophys Acta. 2004;1689(1):13-21. doi: 10.1016/j.bbadis.2004.01.002.
- Tonelli M, Sacks F, Pfeffer M, Gao Z, Curhan G. Cholesterol And Recurrent Events Trial Investigators. Relation between serum phosphate level and cardiovascular event rate in people with coronary disease. Circulation. 2005;112(17):2627-33. doi: 10.1161/CIRCULATIONAHA.105.553198.
- Peng A, Wu T, Zeng C, Rakheja D, Zhu J, Ye T, et al. Adverse effects of simulated hyper- and hypo-phosphatemia on endothelial cell function and viability. PLoS One. 2011;6(8):e23268. doi: 10.1371/journal.pone.0023268.
- Rentrop KP, Cohen M, Blanke H, Philips RA. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol 1985; 5: 587–592. doi: 10.1016/s0735-1097(85)80380-6.
- Karadeniz M, Karadeniz T, Sarak T, Alp Ç. The relationship between serum homocysteine levels and development of coronary collateral circulation in patients with acute coronary syndrome. J Health Sci Med 2020; 3(2): 92-96. doi: 10.32322/jhsm.657326.
- Kostov K, Halacheva L. Role of Magnesium Deficiency in Promoting Atherosclerosis, Endothelial Dysfunction, and Arterial Stiffening as Risk Factors for Hypertension. Int J Mol Sci. 2018;19(6):1724. doi: 10.3390/ijms19061724.
- Banjanin N, Belojevic G. Relationship of dietary magnesium intake and serum magnesium with hypertension: a review. Magnes Res. 2021;34(4):166-171. doi: 10.1684/mrh.2021.0492.
- Zheltova AA, Kharitonova MV, Iezhitsa IN, Spasov AA. Magnesium deficiency and oxidative stress: an update. Biomedicine (Taipei). 2016;6(4):20. doi: 10.7603/s40681-016-0020-6.
- Onufrak SJ, Bellasi A, Shaw LJ, Herzog CA, Cardarelli F, Wilson PW, et al. Phosphorus levels are associated with subclinical atherosclerosis in the general population. Atherosclerosis. 2008;199(2):424-31. doi: 10.1016/j.atherosclerosis.2007.11.004.
- Stevens KK, Denby L, Patel RK, Mark PB, Kettlewell S, Smith GL, et al. Deleterious effects of phosphate on vascular and endothelial function via disruption to the nitric oxide pathway. Nephrol Dial Transplant. 2017;32(10):1617-1627. doi: 10.1093/ndt/gfw252.
- Jang WJ, Yang JH, Choi SH, et al. Long-term survival benefit of revascularization compared with medical therapy in patients with coronary chronic total occlusion and well-developed collateral circulation. JACC Cardiovasc Intv. 2015;8(2):271-279. doi:10.1016/j.jcin.2014.10.010
- Senoz O, Yurdam FS. The effect of postdilatation on coronary blood flow and inhospital mortality after stent implantation in st-segment elevation myocardial infarction patients. Int J Cardiovasc Acad 2021;7:132-9
- Pei J, Wang X, Xing Z. Traditional cardiovascular risk factors and coronary collateral circulation: a meta-analysis. Front Cardiovasc Med. 2021;8:743234. doi:10.3389/fcvm.2021.743234
- Aksu E, Celik E, Dagli M, Tolun FI, Balcioglu AS. Relationship between oxidative stress markers and presence of chronic total occlusion in coronary artery disease. J Coll Physicians Surg Pak. 2022;32(4):430-434. doi:10.29271/jcpsp.2022.04.430
Abstract
Amaç: Koroner kollateral oluşumu, iskemi ve büyüme faktörleri gibi birçok edinsel faktör tarafından tetiklenebilir bu da hastalarda koroner kollateral dolaşımın (KKD) kalitesinde farklılıklar olarak ortaya çıkar. Düşük magnezyum (Mg) seviyeleri endotel hücrelerinin fonksiyon bozukluğunu artırabilir ve potansiyel olarak tromboz ve ateroskleroz riskini artırabilir. Bununla birlikte yüksek serum fosfat (P) seviyelerinin ateroskleroz gelişimi ve mortalite ile ilişkili olduğu bildirilmiştir. Bu çalışmada kronik total oklüzyonda (KTO) KKD kalitesi ile Mg/P oranı arasındaki ilişkiyi araştırmayı amaçladık.
Yöntem: Temmuz 2014 ile Şubat 2018 tarihleri arasında koroner anjiyografide KTO saptanan toplam 269 hasta çalışmaya dahil edildi. Hastalar Rentrop sınıflamasına göre grup I (127 hasta) ve grup II (142 hasta) olarak iki gruba ayrıldı. Çalışma retrospektif, gözlemsel bir çalışmadır.
Bulgular: Çok değişkenli regresyon analizinde; sigara (p=0,004), trigliserid (p<0,001) ve Mg/P oranı (p<0,001) KTO'da KKD'ı etkileyen bağımsız prediktörlerdir. Mg/P değeri grup I'de (0,49±0,17) grup II'ye (0,62±0,12) göre istatistiksel olarak daha düşüktü (p<0,001). Youden indeksi ile hesaplanan ideal Mg/P cut-off değeri 0,56 olup, KTO'da iyi kollateral gelişimi için %69 duyarlılık ve %64 özgüllüğe sahiptir.
Sonuç: Mg/P oranı, koroner kollateral gelişimi etkileyen bir parametredir. Yüksek Mg/P oranı, KTO'su olan hastalarda iyi kollateral gelişim ile ilişkilidir.
Project Number
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References
- McMurtry MS, Lewin AM, Knudtson ML, Ghali WA, Galbraith PD, Schulte F, et al. The clinical profile and outcomes associated with coronary collaterals in patients with coronary artery disease. Can J Cardiol. 2011;27(5):581-8. doi: 10.1016/j.cjca.2011.02.011.
- Nacar AB, Erayman A, Kurt M, Buyukkaya E, Karakaş MF, Akcay AB, et al. The relationship between coronary collateral circulation and neutrophil/lymphocyte ratio in patients with coronary chronic total occlusion. Med Princ Pract. 2015;24(1):65-9. doi: 10.1159/000365734.
- Cui K, Lyu S, Song X, Yuan F, Xu F, Zhang M, et al. Effect of coronary collaterals on prognosis in patients undergoing primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: a meta-analysis. Angiology. 2018; 69:803–11. doi: 10.1177/0003319718768399.
- Volpe SL. Magnesium, the metabolic syndrome, insulin resistance, and type 2 diabetes mellitus. Crit Rev Food Sci Nutr. 2008;48:293–300.
- DiNicolantonio JJ, Liu J, O'Keefe JH. Magnesium for the prevention and treatment of cardiovascular disease. Open Heart. 2018;5(2):e000775. doi: 10.1136/openhrt-2018-000775.
- Li Q, Chen Q, Zhang H, Xu Z, Wang X, Pang J, et al. Associations of serum magnesium levels and calcium-magnesium ratios with mortality in patients with coronary artery disease. Diabetes Metab. 2020;46(5):384-391. doi: 10.1016/j.diabet.2019.12.003.
- Fang X, Liang C, Li M, Montgomery S, Fall K, Aaseth J, et al. Dose-response relationship between dietary magnesium intake and cardiovascular mortality: a systematic review and dose-based meta-regression analysis of prospective studies. J Trace Elem Med Biol. 2016;38:64–73.
- Maier JA, Malpuech-Brugère C, Zimowska W, Rayssiguier Y, Mazur A. Low magnesium promotes endothelial cell dysfunction: implications for atherosclerosis, inflammation and thrombosis. Biochim Biophys Acta. 2004;1689(1):13-21. doi: 10.1016/j.bbadis.2004.01.002.
- Tonelli M, Sacks F, Pfeffer M, Gao Z, Curhan G. Cholesterol And Recurrent Events Trial Investigators. Relation between serum phosphate level and cardiovascular event rate in people with coronary disease. Circulation. 2005;112(17):2627-33. doi: 10.1161/CIRCULATIONAHA.105.553198.
- Peng A, Wu T, Zeng C, Rakheja D, Zhu J, Ye T, et al. Adverse effects of simulated hyper- and hypo-phosphatemia on endothelial cell function and viability. PLoS One. 2011;6(8):e23268. doi: 10.1371/journal.pone.0023268.
- Rentrop KP, Cohen M, Blanke H, Philips RA. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol 1985; 5: 587–592. doi: 10.1016/s0735-1097(85)80380-6.
- Karadeniz M, Karadeniz T, Sarak T, Alp Ç. The relationship between serum homocysteine levels and development of coronary collateral circulation in patients with acute coronary syndrome. J Health Sci Med 2020; 3(2): 92-96. doi: 10.32322/jhsm.657326.
- Kostov K, Halacheva L. Role of Magnesium Deficiency in Promoting Atherosclerosis, Endothelial Dysfunction, and Arterial Stiffening as Risk Factors for Hypertension. Int J Mol Sci. 2018;19(6):1724. doi: 10.3390/ijms19061724.
- Banjanin N, Belojevic G. Relationship of dietary magnesium intake and serum magnesium with hypertension: a review. Magnes Res. 2021;34(4):166-171. doi: 10.1684/mrh.2021.0492.
- Zheltova AA, Kharitonova MV, Iezhitsa IN, Spasov AA. Magnesium deficiency and oxidative stress: an update. Biomedicine (Taipei). 2016;6(4):20. doi: 10.7603/s40681-016-0020-6.
- Onufrak SJ, Bellasi A, Shaw LJ, Herzog CA, Cardarelli F, Wilson PW, et al. Phosphorus levels are associated with subclinical atherosclerosis in the general population. Atherosclerosis. 2008;199(2):424-31. doi: 10.1016/j.atherosclerosis.2007.11.004.
- Stevens KK, Denby L, Patel RK, Mark PB, Kettlewell S, Smith GL, et al. Deleterious effects of phosphate on vascular and endothelial function via disruption to the nitric oxide pathway. Nephrol Dial Transplant. 2017;32(10):1617-1627. doi: 10.1093/ndt/gfw252.
- Jang WJ, Yang JH, Choi SH, et al. Long-term survival benefit of revascularization compared with medical therapy in patients with coronary chronic total occlusion and well-developed collateral circulation. JACC Cardiovasc Intv. 2015;8(2):271-279. doi:10.1016/j.jcin.2014.10.010
- Senoz O, Yurdam FS. The effect of postdilatation on coronary blood flow and inhospital mortality after stent implantation in st-segment elevation myocardial infarction patients. Int J Cardiovasc Acad 2021;7:132-9
- Pei J, Wang X, Xing Z. Traditional cardiovascular risk factors and coronary collateral circulation: a meta-analysis. Front Cardiovasc Med. 2021;8:743234. doi:10.3389/fcvm.2021.743234
- Aksu E, Celik E, Dagli M, Tolun FI, Balcioglu AS. Relationship between oxidative stress markers and presence of chronic total occlusion in coronary artery disease. J Coll Physicians Surg Pak. 2022;32(4):430-434. doi:10.29271/jcpsp.2022.04.430
Details
| Primary Language | English |
|---|---|
| Subjects | Cardiovascular Surgery |
| Journal Section | Research Articles |
| Authors | |
| Project Number | - |
| Publication Date | October 15, 2022 |
| Submission Date | July 23, 2022 |
| Acceptance Date | October 10, 2022 |
| Published in Issue | Year 2022 Volume: 5 Issue: 3 |
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Journal of Health Sciences and Medicine
https://doi.org/10.32322/jhsm.1207234
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